Design and use of vignettes to investigate referral decision-making by optometrists
| Autor: | David J. Parkins, Beju Shah, Martin J Benwell, Bruce John William Evans, David F Edgar |
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| Rok vydání: | 2021 |
| Předmět: |
Optometrists
medicine.medical_specialty Referral media_common.quotation_subject Primary care Secondary care 03 medical and health sciences 0302 clinical medicine medicine Humans Referral and Consultation media_common Selection bias Vignette Continuing education Small sample United Kingdom Reference sample Family medicine 030221 ophthalmology & optometry Original Article Psychology Clinical decision-making 030217 neurology & neurosurgery Optometry |
| Zdroj: | Journal of Optometry |
| ISSN: | 1888-4296 |
| DOI: | 10.1016/j.optom.2020.09.004 |
| Popis: | Purpose This study describes the design and application of a range of online clinical vignettes for measuring the impact of Continuing Education and Training (CET) and identifying unwarranted variation in optometric decision-making concerning referrals to secondary care. Methods Twenty computerised vignettes were developed to assess clinical and referral management decisions taken in primary care optometry. The online system was specifically designed to present vignettes (ten pre-CET and ten post-CET) that avoided prompting correct answers. The main study group was qualified optometrists (N = 31) who chose any CET options available to United Kingdom optometrists over six months. Participants submitted a record of the CET undertaken, which was compared with an anonymised General Optical Council (GOC) reference sample. The vignettes were also completed by newly-qualified (N = 18) and pre-registration (N = 11) groups. Results CET had no significant correlation (p = 0.37) with improvement in optometric clinical decision-making and referral practice (qualified group). Selection bias affected this group who had more CET points (p = 0.008) and peer discussion points (p = 0.003) than the GOC reference sample. Results were indicative due to small sample sizes. Newly-qualified practitioners were significantly more likely to refer than the qualified group (p = 0.004). Number of referrals decreased with time since qualification (p = 0.006). Conclusion Computerised vignettes are a useful tool for comparing referral decisions between groups. Recruiting clinicians for time-consuming vignette studies is challenging. Strategies to reduce unwarranted variation in optometry, including support for newly-qualified optometrists, require further investigation. |
| Databáze: | OpenAIRE |
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